Provider Demographics
NPI:1750557351
Name:MINAS, SUSAN W (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:W
Last Name:MINAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 ROSEBAY DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3342
Mailing Address - Country:US
Mailing Address - Phone:760-274-7179
Mailing Address - Fax:
Practice Address - Street 1:270 ROSEBAY DR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3342
Practice Address - Country:US
Practice Address - Phone:760-274-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS255501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical